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EP2623058A2 - Dispositif de fixation et outil pour systèmes de retenue chirurgicaux - Google Patents

Dispositif de fixation et outil pour systèmes de retenue chirurgicaux Download PDF

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Publication number
EP2623058A2
EP2623058A2 EP12405017.0A EP12405017A EP2623058A2 EP 2623058 A2 EP2623058 A2 EP 2623058A2 EP 12405017 A EP12405017 A EP 12405017A EP 2623058 A2 EP2623058 A2 EP 2623058A2
Authority
EP
European Patent Office
Prior art keywords
joint
ring
eccentric ring
fastening device
tool
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP12405017.0A
Other languages
German (de)
English (en)
Other versions
EP2623058A3 (fr
Inventor
Vincent Vaucher
Markus A. Mueller
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Crcaholic Sa
Original Assignee
Crcaholic Sa
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Crcaholic Sa filed Critical Crcaholic Sa
Priority to EP12405017.0A priority Critical patent/EP2623058A3/fr
Priority to PCT/CH2013/000022 priority patent/WO2013116952A1/fr
Priority to EP18197347.0A priority patent/EP3441032B1/fr
Priority to CN201380018446.0A priority patent/CN104254286B/zh
Priority to US14/376,520 priority patent/US10213242B2/en
Priority to EP13703722.2A priority patent/EP2811911B1/fr
Publication of EP2623058A2 publication Critical patent/EP2623058A2/fr
Publication of EP2623058A3 publication Critical patent/EP2623058A3/fr
Priority to US16/253,835 priority patent/US20190151001A1/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8038—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being inserted in the screw head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8047—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers wherein the additional element surrounds the screw head in the plate hole
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8685—Pins or screws or threaded wires; nuts therefor comprising multiple separate parts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8695—Washers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A61B17/8894—Screwdrivers, spanners or wrenches holding the implant into or through which the screw is to be inserted
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00004—(bio)absorbable, (bio)resorbable or resorptive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/031—Automatic limiting or abutting means, e.g. for safety torque limiting

Definitions

  • the invention relates to the field of surgical restraint systems and, more particularly, to a surgical fastener securing device, a surgical fastener and a surgical restraining tool according to the preamble of the independent claims.
  • Surgical holding systems for example, for fixing broken bones often consist of plates which are fastened by means of screws in the bone.
  • the plates have openings into which the screws are inserted at different angles.
  • a surgical holding system in which a condyle of a screw with a socket in a plate forms a ball joint.
  • the orientation of the screw in the socket can be fixed by means of an eccentrically formed clamping ring.
  • the clamping ring is rotatably mounted to the plate and clamped when rotated against the condyle of the screw.
  • the problem arises that when jamming, due to the geometry of the ball joint and the clamping ring, arise exactly two contact points between the one hand the joint head and the other hand, the joint socket and the clamping ring. This is a consequence of the non-ideal shape of these parts due to manufacturing tolerances. It is then possible that by further, strong clamping of the clamping ring, the parts plastically deform and more Contact points arise. But if this does not happen, the two points of contact define an axis about which the condyle can rotate with respect to the socket, so that the connection is not properly locked in all circumstances.
  • Another object of the invention is to provide a tool with which the fastening device can be safely and easily locked or solved, and also the screw can be screwed off respectively.
  • the fastening device provided for surgical holding systems has at least one holding element and a fastening element, which can be mechanically connected to one another.
  • the retaining element has a socket, and the fastener a joint head.
  • the joint socket and the joint head preferably correspond to each other at least in sections in their shape and together form a ball joint.
  • the movement of the ball joint can be locked by means of a clamping element.
  • the clamping element of the fastening device has a ring with eccentric shape, which clamps the joint head with respect to the joint socket during rotation of the ring and / or braced.
  • the socket and an inner ring surface of the eccentric ring together a joint inner surface of a joint shell in which the joint head is mounted, wherein an outer spherical surface of the joint head of the joint inner surface is opposite.
  • connection systems in which, for example, there is a smooth or a grooved, profiled or otherwise structured surface on the joint inner surface and / or the spherical surface.
  • Such surfaces lead to a variety of contact points, but their location depends on chance and thus is not clearly defined.
  • there are at least three contact points which does not rule out that, under certain geometrical conditions, there is still a fourth, clearly defined contact point, without deformation having taken place on these parts.
  • the eccentric ring is - regardless of whether it is rotatably mounted on the holding element or on the fastening element - usually on the one hand itself, with respect to the center of the ball joint, eccentrically mounted, that is rotatable about an axis which does not pass through this center.
  • contact area (usually as the above contact area) stands for an embodiment of the element which is predetermined by the shape of an element - ie joint socket, condyle or clamping element and thus also recognizable on the element itself.
  • contact point refers to points or areas in which the Jamming the elements rest on each other and the greatest forces are transmitted respectively occur. Where exactly the contact points occur is dependent on the mutual arrangement of the elements and the location of their contact areas. Some of the contact areas become contact points. Conversely, some contact points arise at contact areas, other contact points typically result from pressing one or in particular two contact areas on the elements from an opposite side of the joint.
  • the eccentric ring is rotatably mounted on the holding element and is pressed upon rotation of the eccentric ring with respect to the retaining element of the eccentric ring itself or an eccentric ring moving intermediate element against the joint outer surface, respectively against the joint head
  • An outer surface of the ring, along which the ring is rotatable in the holding element, has a rotationally symmetrical shape.
  • the ring inner surface forms a contact surface with the condyle and can form at least approximately a portion of a spherical surface. When the clamping element is rotated, the contact surface presses against the spherical segment-shaped outer surface of the joint head.
  • the eccentric ring is rotatably mounted on the fastener and is upon rotation of the eccentric ring with respect to the fastener of the eccentric ring itself or one of the eccentric ring moved intermediate element pressed against the inner surface of the joint, respectively against the socket
  • two of the defined contact points arise at two corresponding contact areas by deforming the eccentric ring, in particular on two sides or ends (viewed along the circumference) of a bending-weak point running along the circumference of the eccentric ring.
  • the embodiments described elsewhere with the above contact areas on the eccentric ring can in principle also be realized with this variant with deformation of the eccentric ring.
  • the inner joint surface has exactly two or exactly three inwardly projecting contact areas and the spherical surface has no outwardly projecting contact areas.
  • These contact areas of the joint inner surface may be formed on the ring and / or on the socket, wherein the total number of the above contact areas should be less than or equal to three or four or five.
  • the defined contact points which can be formed according to the different embodiments, viewed in a projection in a plane in which extends the holding element, are distributed at least approximately uniformly on the articular surfaces of the ball joint.
  • the contact areas on the socket can be arranged substantially uniformly on the circumference of a passage for the fastening element, wherein the passage leads through the holding element and the socket.
  • the eccentric ring is rotatably mounted on the fastening element and has the condyle an intermediate element which can be pressed by rotating the eccentric ring against the socket of the retaining element and thereby forms a first contact point and locks the ball joint.
  • the condyle has at least two segments, which are arranged opposite the intermediate element with respect to the condyle, wherein each of the at least two segments defines a contact area and thus a further contact point of the ball joint respectively forms. The ring thus does not touch the retaining element, but only presses against the retaining element via the intermediate element. Thus, again three (or for example four) contact points are clearly defined.
  • the eccentric ring is rotatably mounted on the holding element and the holding element has an intermediate element which can be pressed by rotating the eccentric ring against the spherical surface of the fastening element and thereby forms a first contact point and locks the ball joint.
  • the socket at least two projecting contact areas, which are arranged opposite to the intermediate element with respect to the center of the socket, wherein each of the at least two above contact areas another contact point of the ball joint defined respectively forms. The ring thus does not touch the fastening element, but presses only on the intermediate element against the fastening element.
  • the eccentric ring is rotatably mounted on the fastening element and a portion of the eccentric ring can be pressed by turning the eccentric ring against the socket of the retaining element and thereby forms a first contact point and locks the ball joint.
  • the condyle has at least two segments, which are arranged opposite to the first contact point with respect to the condyle, wherein each of the at least two segments defines a contact area and thus a further contact point of the ball joint respectively forms. This again three (or for example four) contact points are clearly defined.
  • the ball joint can be realized in that both the joint head and the socket - with the exception of the contact areas - have matching spherical surfaces.
  • the joint socket is spherical only in a partial region, and in a remaining region opening towards the clamping element, for example conical, is formed.
  • the partial area lies on the side of the holding element which lies opposite the clamping element, the remaining area lies between the partial area and the clamping element.
  • the joint socket is completely opening towards the clamping element, preferably conical. Also in the second and third embodiments of the invention, due to the spherical shape of the condyle with the acetabulum, a ball and socket joint is formed, and the protruding contact portions can be arranged accordingly.
  • the socket is formed only by three contact areas, and come no other points of the socket ever in contact with the condyle.
  • the fastener is designed substantially rotationally symmetrical with respect to a longitudinal axis of the fastener, wherein a plane which leads through the three defined contact points, this longitudinal axis does not contain. If the longitudinal axis were in this plane, which runs normal or approximately normal to the plane of the retaining element, the distance between the individual contact points would be limited by the thickness of the retaining element. Due to the proximity of the contact points in turn, the holding moment would be relatively small. In order to achieve the highest possible holding torque when locking the ball joint, the mentioned level of the contact points can be as parallel as possible to the plane of the holding element. This is, if the ring is attached to the holding element, substantially the plane of the ring or ring plane (more precisely: a plane which is normal to the axis of rotation of the eccentric ring in the holding element).
  • the retaining element extends in a plane, and has a plane which leads through the three defined contact points, an angle of at most 45 degrees to the plane of the retaining element or the ring plane of the eccentric ring.
  • the smallest distance between the three defined contact points is at least 0.8 times the diameter of the condyle.
  • the holding element or the fastening element (depending on which the eccentric ring is arranged) on a latching element for latching holding the eccentric ring with respect to rotation relative to the holding element or fastener on.
  • the latching element may be a molding on one of the elements involved, or be a separate part. When loosening the ring from the locked position, for example, the ring yields elastically.
  • the outer side of the clamping element may have a shoulder and / or a cone which corresponds to the shape of an annular groove in the retaining element.
  • the clamping element may comprise one or more guides which are suitable for engagement of the tool to perform a clamping movement. For example, these are one or two or more undercut openings for insertion of a tool for rotating the eccentric ring.
  • one or more sockets are formed with corresponding annular grooves.
  • the fastening device described can also be used in other applications, for example in mechanical engineering, for holders and tripods and the like.
  • it can be used in timber construction or generally in the connection of parts to be bonded together by two parts are screwed together after attaching an adhesive by means of the fastening device and pulled against each other with a bias.
  • the fastener elements can be removed.
  • the tool is tool-free in at least two units can be dismantled by at least the inner shaft and other associated parts as the first unit from the outer shaft and related other parts as a second unit tool-free separable and reconnected.
  • the tool can be disassembled by separating the two units by first bringing the two units into a specific position by displacement along a longitudinal axis of the tool, and then slid the two units apart after rotation about the longitudinal axis.
  • one of the tool tips is designed to hook with a member to be rotated, wherein the shaft corresponding to the tool tip is designed to be flexible and rotationally rigid. If the tool tip is caught with the element to be rotated, the tool can not slip when applying a torque. This is important and advantageous in surgical work.
  • the disadvantage may be that a tilting of the longitudinal axis of the tool can exert a moment on the element to be rotated. For this reason, the flexurally elastic portion of the shaft is provided.
  • the tool it is the outer tool tip which is adapted to catch with an element to be rotated therewith, and thus it is the outer shaft which is elastically bendable and torsionally rigid in an elastic region.
  • the inner shaft In order for the outer shaft to bend, in the same area along the length of the outer shaft either the inner shaft itself should also be flexurally elastic, or leave room for the bending of the outer shaft. The latter can for example be done by the inner shaft is pulled so far inward, that this area is completely free, or by the inner Shank, when the outer shaft is in working position, at the location of this elastic region has a taper.
  • the tool has an asymmetrically acting torque limiter, in particular for the outer shaft.
  • FIG. 1 shows a fastening device with a holding element 1, a fastening element 2 and a clamping element 12th
  • FIG. 2 shows the different elements in a sectional drawing.
  • the fastening element 2 with a joint head 3 is in a holding element 1, which has a receptacle for the fastening element 2 with a socket 8, inserted.
  • the fastening element 2 has a receptacle 6 for a tool and a shaft 4.
  • the shaft 4 passes through a passage 20 of the retaining element 1, it is for example provided with a thread 5 and can be screwed into a substrate to be fixed or stabilizing, for example in a bone.
  • the fastening element 2 in the holding element 1 is rotatably movable.
  • the holding element 1 is not translationally movable along the fastening element 2.
  • the ball joint can be fixed or fixed by a clamping element or a ring 12.
  • the ring has an opening 17, and opposite a bending weak point 7, which are provided for a simplified mounting of the ring 12 in a circumferential annular groove 10 of the retaining element 1.
  • FIG. 3 shows the ring 12 alone in two different views 3a and 3b , and FIG. 4 the ring 12 inserted into the holding element 1.
  • the opening 17 on the clamping element or ring 12 is a widening and compression of the ring 12 allows.
  • the clamping element 12 can be compressed and inserted into the annular groove 10.
  • ring 12 and groove 10 may be formed corresponding to each other conically.
  • the annular groove 10 is arranged eccentrically relative to the center of the joint head 3 and optionally also a longitudinal axis of the fastening element 2.
  • the center of a ring inner surface 14 of the clamping element 12 shifts and thus locks the joint head 3 relative to the socket joint 8 respectively dissolves it.
  • the combination of socket 8 and inner ring surface 14 of the clamping ring 12 forms a joint shell with an inner surface or inner joint surface, which may be an inner ball surface 15, in which the joint head 3 is mounted.
  • an inner surface or inner joint surface which may be an inner ball surface 15, in which the joint head 3 is mounted.
  • the ring inner surface 14 and / or the socket 8 have projecting contact areas 16, there are clearly defined areas where a clamping force is exerted on the condyle 3 when clamping the ring 12. These areas define at least three points at which the condyle 3 is held and thus its orientation is clearly defined.
  • FIG. 5 shows a ring 12 in another embodiment.
  • This has an outer opening 21 a, and corresponding to a thinner, low-bending region of the ring (with respect to bending within the plane of the ring).
  • the outer opening 21 a thus protrudes from the outside in the direction of the center of the ring in this.
  • This can be a regular joint inner surface or ball inner surface 15 without projecting protrusions.
  • transition areas 21b In transition areas 21b, in which the low-bending point begins or stops, the greatest pressure forces between the joint head 3 and the inner surface 14 of the ring 12 occur. This corresponds to two further contact areas 16a, which thus clamps and holds the joint head 3, together with a resulting opposite contact point on the holding element 2, at three points. The position of the two contact areas 16a as well as the opposite contact point on the holding element 2 is thus clearly defined by the position of the transition regions 21 b on the ring 12.
  • FIG. 6 shows a fastening device in a further embodiment, FIG. 7 in a sectional drawing.
  • the elements are fundamentally the same in their shape and function, with the difference that on the ring 12 no protruding contact areas 16 are present, but on the retaining element 1 on the socket joint 8 as part of the inner joint surface respectively ball inner surface 15 projecting contact areas 16, for example in the field of implementation 20.
  • FIG. 8 shows a plan view from the side of the socket 8 forth on the holding element 1 with inserted ring 12, FIG. 9 the same supervision without the ring 12th
  • FIG. 10 shows a view from below, ie from the side of the passage 20 ago.
  • FIG. 11 shows a cross section through a retaining element 1 with inserted ring 12th
  • a latching element 19 protrudes into the annular groove 10, and engages in a corresponding recess 22 on the shoulder 13 of the ring 12 (see FIGS. 3a and 3b ).
  • the latching element 19 may be realized as drawn by design reasons by an inserted pin, but may be formed according to other embodiments as part of the annular groove 10 on the holding element 1. Due to the interaction of latching element 19 and recess on the ring can - depending on the design of the recess - engage and held the ring in a defined position in which the fastener 2 can be used easily. And / or the rotational movement of the ring 12 can be limited to a predetermined range. Such a latching element 19 can of course also in the embodiment of the Figures 1-4 will be realized.
  • the opening 17 and / or a further opening 21 of the ring 12 may be formed undercut. Then, a tool for rotating the ring 12 can be inserted into the opening 17, 21, and be hooked by twisting about the axis of rotation of the ring 12 with this. That is, for example, the area through which the tool is inserted into the opening 17, 21, smaller than a further inwardly located portion of the opening 17, 21. When pulling along the axis of the fastener or the tool so the tool does not slip out the opening 17, 21. The tool is retained by means of a portion of the opening 17, 21 projecting portions of the ring. The flanks of these sections may be obliquely shaped, so that when the tool is rotated about the axis, the tool is pulled into the opening 17, 21.
  • FIG. 3b is the location of undercut areas on both sides of the opening 17 indicated by dotted lines.
  • Such an undercut opening 17, 21 may in the embodiments of Figures 1-4 as well as the Figures 5-10 will be realized.
  • FIGS. 12 to 15 show various views and sections of an embodiment with contact areas on the condyle, wherein the ring 12 is rotatably mounted on the joint head 3.
  • the joint inner surface 15 of the joint socket 8 can be a regular ball inside surface without protruding formations.
  • the ring 12 is an eccentric ring and is rotatably mounted about a central portion 43 of the joint head 3 about an axis which is eccentric, that is not identical to the longitudinal axis of the fastener 2, and does not pass through the center of the ball joint.
  • the condyle 3 has three segments 42, one of which, referred to below as an intermediate element 41, may be formed such that it is elastically yielding with respect to radial forces than the other segments.
  • the three segments 42, 41 are distributed approximately uniformly around the circumference of the condyle 3, in the radial direction outside the ring 12.
  • a portion of increasing thickness of the ring 12 between the middle part 43 and the intermediate member 41 are pushed, whereby the intermediate member 41 in the radial direction outwards and against the inner joint surface 15 of the Holding element 1 is pressed.
  • the condyle 3 is clamped and locked between the intermediate element 41 and the other two segments 42.
  • Three projecting contact areas 16 which define the contact points on the joint are thus defined by the outer sides of the segments 42 and the intermediate element 41.
  • FIGS. 16 to 19 show different views and sections of another embodiment with contact areas on the condyle, wherein the ring 12 is rotatably mounted on the condyle 3.
  • the joint inner surface 15 of the joint socket 8 can be a regular ball inside surface without protruding formations.
  • the ring 12 is an eccentric ring and is rotatable about a central portion 43 of the joint head 3 about an axis which is eccentric, that is not identical to the longitudinal axis of the fastening element 2, and does not pass through the center of the ball joint.
  • the condyle 3 has two relatively short segments 42. The two segments 42 are arranged on two of three approximately uniformly distributed around the circumference of the condyle 3 points in the radial direction outside of the ring 12.
  • the shortened segments 42 of the embodiment of the FIGS. 16-19 can also in the embodiment of the FIGS. 12-15 be used, and conversely, the larger segments 42 of the embodiment of the FIGS. 12-15 in the embodiment of the FIGS. 16-19 , In the embodiments of the FIGS. 12-19 can as in the embodiment of Figures 6 - 11 the socket 8 have projecting contact areas 16.
  • FIGS. 20 to 24 show a fastening device in which a screw ring 12a is rotatably mounted on the joint head 3.
  • the threaded ring may be rotatable about an axis through the center of the ball joint, so not be arranged eccentrically with respect to the joint head 3.
  • the condyle 3 has in the circumferential direction a plurality of segments 42, which are separated by slots and thereby can be pushed outwards.
  • An inner side of the segments 42 (seen in the radial direction) is conically shaped, and the screw ring is formed at its outer periphery as a corresponding outer cone.
  • FIGS. 1 to 24 each sections of a surgical holding element 1 are shown.
  • a complete surgical holding element 1 preferably has a plurality of receptacles for fastening elements 2.
  • single joint embodiments could also be applicable.
  • FIGS. 25 and 26 show bushings 30 for use in the fastening device, in a view and a cross section.
  • a drill bush 30 has a cylindrical guide opening 31 for guiding a drill. An inner diameter of the guide opening thus corresponds to an outer diameter of the provided Drill.
  • the drill bushes 30 are shaped the same as the rod ends, with an outer spherical surface 34, and thus form a ball joint with the socket 8 and the ring 12. By rotating the ring 12 and thus this ball joint is thus locked.
  • a plurality of drill bushings 30 may be connected to each other by connecting elements or connecting webs 32. These connecting webs 32 form a captive and allow easy handling of a set of Bohrbuchsen 30.
  • the connecting webs 32 may be formed of elastic material and may have compensation areas 33, so that the Bohrbuchsen 30 are movable by itself, in particular for adjusting their orientation in the Articulated pans 8.
  • the drill bushings 30 are made, for example, of a material which is absorbable in the absorbable material which is degradable in the body, so that chips or abrasion produced during drilling are unproblematic.
  • FIG. 27 shows a drill bush 30 with a stop 35, which limits the rotation of the drill bushing 30 in the socket 8.
  • the stopper 35 may be a projecting ring, or a plurality of annularly arranged projecting elements, which are arranged in a plane normal to the axial direction of the guide opening. As a result, they limit a rotation of the drill bushing to a maximum angular deviation from a normal to the surface of the retaining element 1.
  • the drill bushes 30 are used to guide a drill for pre-drilling holes, typically in a bone, prior to inserting or screwing in the fasteners or screws 2.
  • the Bohrbuchsen 30 can be used before use in the holding element 1 or already used used.
  • the drill bushes 30 can be oriented as needed and then locked by means of the ring 12. Then, the holding element 1 is brought into the desired end position with respect to the bone to be held, and it will be created using the Bohrbuchsen 30, the holes in the bone. If after drilling a hole, the corresponding fastener 2 is to be used before the other holes are drilled, the corresponding drill bushing 30 can be removed. In this case, the connecting webs 32 are cut to other, still used Bohrbuchsen or broken off, for example, at a predetermined breaking point (not shown).
  • the outer shaft 114 and the telescopic sleeve 107 are displaceable with respect to the inner shaft 103 and the handle 109 along a longitudinal axis, ie in the axial direction.
  • the inner shaft 103 extends inside the outer shaft 114, for example, coaxially.
  • a first shift position FIG. 28
  • the outer shaft 114 is retracted so that the inner tool tip 117 can be used.
  • a second shift position FIG. 29
  • the outer shaft 114 is extended so that the outer tool tip 116 can be used.
  • a locking element 106 is provided, for releasing the locking a triggering element 105, which can be actuated by a trigger button 101 ( FIG. 31 ).
  • the locking element 106 has a locking head 106a, and elastic locking tongues 106b with locking latches 106c at the end thereof.
  • the locking latches 106c engage from the inside to rear or front locking grooves 118, 119 of the telescopic sleeve 107 a. In the first shift position ( FIG. 28 ) they engage in the front detent groove 119, in the second shift position ( FIG. 29 ) In the rear detent groove 118.
  • the trigger button 101 is pressed inward against the force of a spring 102, thereby pushing the trigger member 105 with a trigger finger 105a over the latch tabs 106b and pushing the latch tabs 106b inwardly, and thus also presses the locking catches 106c inward and pulls out of the locking groove.
  • the inside of the telescopic sleeve 107 which moves along the locking tongues 106b and locking catches 106c, have a narrowed point or braking point 108, which is located along the direction of movement of the locking tongues 106b in front of the rear locking groove 118.
  • Moves the telescopic sleeve 107 forward then push the locking tabs 106 b at the brake point 108 against the inside of the telescopic sleeve 107, are pushed inward and thereby brake the movement of the telescopic sleeve 107 before the outer tool tip 116 in the region of the inner tool tip 117 arrived.
  • Said slot 120 of the inner shaft extends in the longitudinal direction of the inner shaft 103, so that the pin 111 of the telescopic sleeve 107 protrudes into the slot 120 irrespective of the shift position.
  • Said torque limiter 112 is disposed between a front end of the telescoping sleeve 107 and an end portion 114 a of the outer shaft 114.
  • the end piece 114a is pulled against the torque limiter 112 with a sleeve head 113 attached to the telescoping sleeve 107.
  • a sliding member 124 may be arranged to reduce the friction between the sleeve head 113 and tail 114a.
  • the outer tool tip 116 can catch with, for example, a ring 12 of a fastening element 2, large forces can occur on the fastening element 2 due to the lever arm which the tool forms. This can lead to damage and / or displacement of the fastener or associated broken bones.
  • the outer shaft 114 may be elastically flexible and torsionally rigid or have an elastic region 115, which has a higher elasticity, in particular bending elasticity, compared with the other regions of the outer shaft 114, but is torsionally stiff in order to be able to transmit a torque.
  • helical cuts can be present on the outer shaft 114, or a torsion spring can be installed. So that the inner shaft 103 does not block the bending of the outer shaft 114, the inner shaft 103 is formed at the height of the elastic region 115 (with the outer shaft extended) and further forward, towards the inner tool tip 117
  • the torque limiter 112 may have two spring members pressed against each other, which generate the torque by friction.
  • FIGS. 32 to 33 show alternatively the operation of a variant for an asymmetrically acting torque limiter 112. Shown is in each case a portion of an upper ring 112a and a lower ring 112b, which by a force F in the axial direction, ie pressed parallel to the longitudinal direction of the tool against each other.
  • the two rings 112a, 112b have symmetrical projections 112c. Several such projections 112c are circumferentially regularly distributed around the rings 112a, 112b. Between the two rings balls or rollers 112d are arranged.
  • the rings 112a, 112b rotate about the axial direction, they roll over the rollers 112d until the rollers 112d abut the projections 112c.
  • a multiple or a fraction of the force F is applied to each projection in the horizontal direction in order to remove the rings 112a, 112b from each other. This results in a corresponding maximum torque at which the torque limiter rotates. Due to different steepness of the flanks on the two sides of the projections 112c, the maximum torque in the two directions of rotation can be selected separately. In the example shown begins in FIG. 32 at a first torque, the lifting of the upper ring 112a and thus the spin.
  • the maximum moment in locking the fastening device (for example, by clockwise rotation) is determined by the construction and materials of the fastening device. For unlocking, however, a higher maximum torque is set.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Neurology (AREA)
  • Dentistry (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
EP12405017.0A 2012-02-06 2012-02-06 Dispositif de fixation et outil pour systèmes de retenue chirurgicaux Withdrawn EP2623058A3 (fr)

Priority Applications (7)

Application Number Priority Date Filing Date Title
EP12405017.0A EP2623058A3 (fr) 2012-02-06 2012-02-06 Dispositif de fixation et outil pour systèmes de retenue chirurgicaux
PCT/CH2013/000022 WO2013116952A1 (fr) 2012-02-06 2013-02-05 Dispositif de fixation et outil pour systèmes de maintien chirurgicaux
EP18197347.0A EP3441032B1 (fr) 2012-02-06 2013-02-05 Dispositif de fixation et outil pour systèmes de retenue chirurgicaux
CN201380018446.0A CN104254286B (zh) 2012-02-06 2013-02-05 用于外科的保持系统的固定装置和工具
US14/376,520 US10213242B2 (en) 2012-02-06 2013-02-05 Fastening device and tool for surgical holding systems
EP13703722.2A EP2811911B1 (fr) 2012-02-06 2013-02-05 Dispositif de fixation pour systèmes de maintien chirurgicaux
US16/253,835 US20190151001A1 (en) 2012-02-06 2019-01-22 Fastening device and tool for surgical holding systems

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
EP12405017.0A EP2623058A3 (fr) 2012-02-06 2012-02-06 Dispositif de fixation et outil pour systèmes de retenue chirurgicaux

Publications (2)

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EP2623058A2 true EP2623058A2 (fr) 2013-08-07
EP2623058A3 EP2623058A3 (fr) 2013-09-11

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EP12405017.0A Withdrawn EP2623058A3 (fr) 2012-02-06 2012-02-06 Dispositif de fixation et outil pour systèmes de retenue chirurgicaux
EP18197347.0A Active EP3441032B1 (fr) 2012-02-06 2013-02-05 Dispositif de fixation et outil pour systèmes de retenue chirurgicaux
EP13703722.2A Not-in-force EP2811911B1 (fr) 2012-02-06 2013-02-05 Dispositif de fixation pour systèmes de maintien chirurgicaux

Family Applications After (2)

Application Number Title Priority Date Filing Date
EP18197347.0A Active EP3441032B1 (fr) 2012-02-06 2013-02-05 Dispositif de fixation et outil pour systèmes de retenue chirurgicaux
EP13703722.2A Not-in-force EP2811911B1 (fr) 2012-02-06 2013-02-05 Dispositif de fixation pour systèmes de maintien chirurgicaux

Country Status (4)

Country Link
US (2) US10213242B2 (fr)
EP (3) EP2623058A3 (fr)
CN (1) CN104254286B (fr)
WO (1) WO2013116952A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2571434A1 (fr) * 2010-05-17 2013-03-27 Medicrea International Système de retenue d'un élément d'ancrage sur une partie implantable

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8940030B1 (en) 2011-01-28 2015-01-27 Nuvasive, Inc. Spinal fixation system and related methods
FR2978343B1 (fr) * 2011-07-25 2013-08-23 Medicrea International Organe d'ancrage pour materiel d'osteosynthese vertebrale
US9987043B2 (en) 2014-10-24 2018-06-05 Stryker European Holdings I, Llc Methods and systems for adjusting an external fixation frame
US10368913B2 (en) * 2015-08-10 2019-08-06 Stryker European Holdings I, Llc Adjustment instrument with tactile feedback
DE102018121683A1 (de) * 2018-09-05 2020-03-05 Aesculap Ag Haltevorrichtung zum Halten eines medizintechnischen Werkzeugs und Verpackung mit einer solchen Haltevorrichtung

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2010121388A1 (fr) 2009-04-20 2010-10-28 Creaholic S.A. Dispositif de fixation pour systèmes de maintien chirurgicaux

Family Cites Families (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5464407A (en) 1991-02-19 1995-11-07 Mcguire; David A. Flexible surgical screwdriver and methods of arthroscopic ligament reconstruction
US20040019353A1 (en) * 2002-02-01 2004-01-29 Freid James M. Spinal plate system for stabilizing a portion of a spine
US7303564B2 (en) * 2002-02-01 2007-12-04 Spinal Concepts, Inc. Spinal plate extender system and method
US6695846B2 (en) * 2002-03-12 2004-02-24 Spinal Innovations, Llc Bone plate and screw retaining mechanism
AU2003901971A0 (en) * 2003-04-23 2003-05-15 Dugal Simon Stewart James A fixation device and method of fixation
DE20318703U1 (de) * 2003-11-24 2004-02-19 Stryker Trauma Gmbh Schraubendreher für Knochenschrauben
US7175626B2 (en) * 2004-06-15 2007-02-13 Board Of Regents Of The University Of Nebraska Dynamic compression device and driving tool
US20080154277A1 (en) * 2004-10-26 2008-06-26 Scott Machalk Tool apparatus for locking a spinal rod in an anchoring device therefor
US7691133B2 (en) * 2004-11-30 2010-04-06 Integra Lifesciences Corporation Systems and methods for bone fixation
EP2097028B1 (fr) * 2006-12-18 2013-09-11 Greatbatch Medical SA Dispositif d'entraînement orthopédique mécanique calibré avec mécanisme limiteur de couple à compensation d'usure
US8702762B2 (en) * 2007-03-27 2014-04-22 Depuy Spine, Inc. Passive screw locking mechanism
US8556944B2 (en) * 2007-07-31 2013-10-15 Stryker Spine System and method for vertebral body plating
US8852247B2 (en) * 2007-12-07 2014-10-07 Custom Spine, Inc. Orthopedic anti back-out mechanism
US8585743B2 (en) * 2008-09-15 2013-11-19 Biomet C.V. Low profile screw and washer system for bone plating
CA2735683A1 (fr) * 2008-09-18 2010-03-25 Synthes Usa, Llc Systeme vis-plaque transpediculaire anterieur
US8211154B2 (en) * 2009-04-06 2012-07-03 Lanx, Inc. Bone plate assemblies with backout protection and visual indicator
US8529609B2 (en) * 2009-12-01 2013-09-10 Osteomed Llc Polyaxial facet fixation screw system
MX2012000992A (es) * 2009-07-24 2012-06-27 Spinal USA LLC Sistema de placa de hueso y metodos de uso de la misma.
EP2490606B1 (fr) * 2009-10-21 2018-02-28 International Spinal Innovations, LLC Plaque vertébrale avec verrouillage en compression
EP2624771B1 (fr) * 2010-10-07 2015-12-30 Biedermann Technologies GmbH & Co. KG Ensemble plaque osseuse comportant un élément de guidage
US9241807B2 (en) * 2011-12-23 2016-01-26 Pioneer Surgical Technology, Inc. Systems and methods for inserting a spinal device
US8734495B2 (en) * 2012-01-18 2014-05-27 Globus Medical, Inc. Securing fasteners

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2010121388A1 (fr) 2009-04-20 2010-10-28 Creaholic S.A. Dispositif de fixation pour systèmes de maintien chirurgicaux

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2571434A1 (fr) * 2010-05-17 2013-03-27 Medicrea International Système de retenue d'un élément d'ancrage sur une partie implantable

Also Published As

Publication number Publication date
EP2811911B1 (fr) 2018-10-31
US20190151001A1 (en) 2019-05-23
EP3441032B1 (fr) 2022-08-24
EP3441032A1 (fr) 2019-02-13
EP2623058A3 (fr) 2013-09-11
CN104254286A (zh) 2014-12-31
CN104254286B (zh) 2017-05-24
WO2013116952A1 (fr) 2013-08-15
EP2811911A1 (fr) 2014-12-17
US10213242B2 (en) 2019-02-26
US20150045840A1 (en) 2015-02-12

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